Bereavement grief: A population-based foundational evidence study

Information is needed on the incidence and prevalence of bereavement grief, and factors associated with severe or prolonged grief. Among 1,208 representative Canadian adults, 96% had experienced bereavement grief and 78% were actively grieving at interview. Grief levels were higher among women, Protestants, and Catholics, when the death was under 2 years previously, when a spouse, parent, or child had died, and when the perceived death quality was lower. This study reveals the importance of good deaths; they are essential for dying people and also those who mourn their deaths.     

Critical care nurses' experiences of grief in an adult intensive care unit

Title.  Critical care nurses' experiences of grief in an adult intensive care unit.
Aim.  This paper is a report a study of critical care nurses' experiences of grief and their coping mechanisms when a patient dies.
Background.  The goal of patients entering critical care is survival and recovery. However, despite application of advanced technologies and intensive nursing care, many patients do not survive their critical illness. Nurses experience death in their everyday work, exposing them to the emotional and physical repercussions of grief.
Method.  This study adopted a Heideggerian phenomenological approach, interviewing eight critical care nurses. Data collection occurred in 2007/8. Interviews were transcribed verbatim and themes generated through Colaizzi's framework.
Findings.  Participants reported feelings of grief for patients they had cared for. The death of a patient was reported as being less traumatic if the participant had perceived the death to be a 'good death', incorporating expectedness and good nursing care. They described how a patient's death was more significant if it 'struck a chord', or if they had developed 'meaningful engagement' with the patient and relatives. They denied accessing formal support: however, informal conversations with colleagues were described as a means of coping. Participants exhibited signs of normalizing death and described how they disassociated themselves emotionally from dying patients.
Conclusion.  There are many predisposing factors and circumstantial occurrences that shape both the nature of care of the dying and subsequent grief. Repeated exposure to death and grief may lead to occupational stress, and ultimately burn out. Emotional disengagement from caring for the dying may have an impact on the quality of care for both the dying patient and their family.     

TRAINING HEALTH PROFESSIONALS IN CARING FOR DYING CHILDREN AND GRIEVING FAMILIES

In most industrialized countries today, the death of a child is a rare phenomenon. When it occurs, however, it is usually within a hospital setting, after the child has received complex and often long-term medical care aimed at curing or controlling a serious disease. Thus, health professionals are increasingly exposed to the dying process and death of a child with little prior education to help them deal with the particular needs of young patients and minimal preparation in recognizing and handling their personal reactions in the face of death. Comprehensive training programs in pediatric hospice care could help professionals cope with the growing and unique needs of terminally ill children and of their families but these should be differentiated from training programs designed for the terminal care of adult patients. The purpose of this article is to describe and discuss some of the challenges involved in the training of health professionals (pediatricians, nurses, psychologists, social workers, clergy) who wish to provide services to dying children and grieving families. These challenges include (a) definition of educational objectives, (b) selection of teaching methods and content of training, (c) definition and teaching of emotional involvement, (d) support of training participants, (e) promotion of interdisciplinary collaboration, (f) evaluation of the training process and its outcomes, and (g) background and skills of educators. The challenges are discussed and references are made to illustrate how they were met by a 600-hour training program on home-based palliative care for children dying of cancer conducted at the University of Athens.     

Training health professionals in caring for dying children and grieving families

In most industrialized countries today, the death of a child is a rare phenomenon. When it occurs, however, it is usually within a hospital setting, after the child has received complex and often long-term medical care aimed at curing or controlling a serious disease. Thus, health professionals are increasingly exposed to the dying process and death of a child with little prior education to help them deal with the particular needs of young patients and minimal preparation in recognizing and handling their personal reactions in the face of death. Comprehensive training programs in pediatric hospice care could help professionals cope with the growing and unique needs of terminally ill children and of their families but these should be differentiated from training programs designed for the terminal care of adult patients. The purpose of this article is to describe and discuss some of the challenges involved in the training of health professionals (pediatricians, nurses, psychologists, social workers, clergy) who wish to provide services to dying children and grieving families. These challenges include (a) definition of educational objectives, (b) selection of teaching methods and content of training, (c) definition and teaching of emotional involvement, (d) support of training participants, (e) promotion of interdisciplinary collaboration, (f) evaluation of the training process and its outcomes, and (g) background and skills of educators. The challenges are discussed and references are made to illustrate how they were met by a 600-hour training program on home-based palliative care for children dying of cancer conducted at the University of Athens.     

Death of a child at home or in hospital: experiences of Greek mothers

The purpose of this study was to investigate the experiences of Greek mothers who cared for a child dying of cancer at home or in the hospital, and to highlight some of their major needs during the terminal period. Fifteen mothers were interviewed and both quantitative and qualitative procedures were used to analyze the findings. Ten families (67%) chose to care for the child at home without having access to home care services, while the remaining five sought hospital care. Their decision was primarily based upon the child's expressed wish and parental preference. The family network played a significant role in supporting the mother-child unit, especially when death occurred at home. Mothers assessed positively the services provided by nurses and social workers, and had expectations that physicians would support them on a psychological level during the terminal period. The care of the dying child is influenced by cultural factors predominant in Greek society and some of the findings are discussed in this light.     

Death of adolescents: parental grief and coping strategies

The death of an adolescent is a particularly complex issue. The process of grieving and coping can be complicated by the tension that may have existed in the parent/child relationship because of the conflict in terms of personal ideology at this stage in the adolescent's development. As a result, parents of adolescent children who die have the potential to experience abnormal grief reactions. Parental coping strategies vary according to the mode of death and outlook adopted by the parents, although some studies suggest parents bereaved of adolescent children do not exhibit marked difference in grieving or coping in comparison to other groups of parents. Healthcare professionals must recognize the specific and special needs of this parent group, and provide appropriate support to minimize the risk of harmful sequelae that may occur as a result of inappropriate and insensitive care.     

Strategies for discussing death with child cancer sufferers

Since a curriculum concerning life and death was established and palliative care began to be promoted, people have gradually awakened to the needs of dying patients. Because of the nature of oriental culture, however, ultimate decisions concerning someone with a terminal disease have traditionally been made by family, so dying patients, especially children with cancer, have usually not been told of their true condition. The purpose of this article was to gain an understanding of the necessity of talking about death with child cancer patients and how to communicate with these children. The results show that helping the family to talk about death and decision making concerning treatment can help them to adapt to the grieving period when the children pass away. The tactics that nurses can use for communication with dying children include: to acknowledge the decision maker in the family, adopt the concept of death appropriate to a person of the child's age, discuss the prognosis for the development of the disease, and opt to use the medium of communication. The findings of this article may serve as a source of reference for nurses caring for dying children, and cause greater attention to be paid to these issues.     

The staff's experience of the death of a child and of supporting the family

The purpose of the study was to describe how staff members experience the death of a child and how they support the grieving family. The goal is to find means to improve supporting activities in the university hospital. The data for this study were collected with a questionnaire given to the staff who encounter the death of a foetus or infant at their work (n = 102). The questionnaire contained both structured and open-ended questions. Altogether, 69 members of the staff (68%) answered the questionnaire. The open-ended questions were analysed using content analysis. The staff experiences of a child's death manifested themselves in grief, feelings of injustice, experiences of one's limited resources, and relief. About half (51%) of the respondents estimated that they were able to support families rather well. Education in supporting the grieving family increased the ability to support families. Social support for families included emotional, informational, and concrete support. The majority of the staff expected support from colleagues after the death of a child. The study results show that the hospital staff supports the grieving family, but also recognizes their inadequacy as supporters. The staff also needs support in order to be able to support the grieving family.     

Dwelling with stories that haunt us: building a meaningful nursing practice

The purpose of this article is to reflect on pediatric critical care nurses' experience of grief by focusing on the meaning of the stories that haunt them. It is suggested that these stories are the nurses' attempt to find ways to journey through their grief and to live with the mystery of life and death. It is also the task of these stories to throw light on their experiences, a task that is never entirely finished. Dwelling with the stories that haunt them helps to provide nurses with a moral structure of critical care nursing practice. Their reflections upon the meaning of their experiences of grief can lead to a view of death that is not always perceived as an evil to flee, but is upheld as a source of value and revelation as critical care nurses strive to build who they are and how they practice the art of nursing.     

A memorial service for families of children who died from cancer and blood disorders

The grief of staff who work with dying children and the grief of family members after the death of a child has been widely documented. Interventions to facilitate grieving have been extensively developed for parents but less so for siblings and staff. This article describes one approach, a memorial service, for families and staff that has wide applicability for providing support after a death. The memorial service provides families and staff with a healing ritual of remembrance, a source of closure after the death, and a recognition of the relationships established between families and staff. The service particularly legitimizes the staff's grief experience. The organization, implementation, and evaluation of such a program is discussed.     

Situations Involving Children: A Challenge for the Hospice Movement

Situations wherein children and their families become involved with problems of dying, death, and bereavement constitute an important challenge for the hospice movement. Such situations represent an opportunity for hospice programs and caregivers to add quality to the lives of vulnerable people, while also growing in their own self-understanding and appreciation. This article surveys three sorts of situations involving children which are appropriate for care in the hospice mode: (1) grieving or bereaved children; (2) adults who are grieving or bereaved in relation to the illness or death of a child; and (3) ill or dying children. Issues to be considered are identified and practical recommendations are offered for those who choose to enter into such care.     

Grief and bereavement.

Grief and bereavement are frequent concerns of primary care physicians. This article outlines grief in terminally ill patients and discusses interventions. Also included in this article is a review of the process of anticipatory grief and mourning and a discussion on normal and complicated grief. A portion of this article also covers grief in children and discusses interventions for grieving children.     

Brain death and organ donation

Critical care nurses are essential team members during the process of determining brain death and preparing for organ donation. Using their knowledge of the criteria for brain death, they care for the dying patient, support the grieving family, and participate in the consent process for organ donation. Nurses make a critical difference in saving the lives of others through the gift of life.     

Attitudes toward death: a survey of nursing students.

The literature devoted to the topics of death and care of the dying is expanding rapidly. As nurses are inevitably involved in terminal illness, death and grief, their attitudes toward death and factors which affect these attitudes, are worthy of study. This report describes the results of a continuing two-year survey of one class of students in a baccalaureate nursing program. A questionnaire was used at the beginning and end of one academic year. Data were obtained regarding background experiences with death, involvement in the care of dying patients, and common ideas, concerns and feelings about death. Data from the second testing also included perceived changes in "positive" and "negative" attitudes toward death, and the relative effect on attitudes of various factors during the year. Suggestions are offered for curriculum development and research in the challenging area of death education in nursing.     

Cultural practices and end-of-life decision making in the neonatal intensive care unit in Taiwan

The purpose of this research was to describe conditions of decision making for dying infants and cultural effects on the process of infant death in the neonatal intensive care unit. A retrospective chart review was used in this research. Fifty charts were reviewed; the major cause of death for the research subjects was complications of prematurity (52%). Eighty-two percent of the charts documented a do not resuscitate order, and 16% of parents allowed discontinuation of ventilator support when they realized the futility of continued care. In 30 nursing records, parents and their dying infants were offered a quiet place in which to grieve. In 10 cases, nurses accompanied these parents and allowed them to express their emotions. Research findings showed great outward expression of religion at the time of death. Various cultural issues affected both the grieving process of the families and the dying process of their infants.     

Parental grief following the brain death of a child: does consent or refusal to organ donation affect their grief?

The purpose of this study was to investigate the grieving process of parents who were faced with the dilemma of donating organs and tissues of their underage brain dead child, and to explore the impact of their decision on their grief process. A grounded theory methodology was adopted and a semi-structured interview was conducted with 11 bereaved parents who consented to, and 11 parents who declined organ donation. Findings suggest that the core themes that characterize their grief and the main variables that affect their grieving process are similar for both donor and non-donor parents. Consent or refusal of organ donation per se does not seem to affect the overall grieving process. It is the meaning attributed to the act of donation that affects how parents perceive the child's death and subsequently facilitate or hinder their adjustment to loss.